Buruli ulcer

Buruli ulcer is a slowly progressive necrotizing disease of the skin caused by Mycobacterium ulcerans, recognized by WHO as a neglected tropical disease. Around 2,000 cases are reported annually, but underdiagnosis and under-reporting probably obscure the true burden. A major advance in the understanding of Buruli ulcer pathogenesis was the discovery that mycolactone, a lipid-like exotoxin secreted by M. ulcerans, inhibits the Sec61 translocon, driving tissue destruction and immune suppression. M. ulcerans is an opportunistic environmental pathogen; however, its mechanisms of transmission remain unclear in most regions. PCR is the current gold standard for diagnosis, but its cost and technical demands limit use in resource-limited settings. Treatment is available with an oral regimen of rifampicin plus clarithromycin for 8 weeks, but further research is in progress to explore alternative drugs, optimized dosing and duration, and improved affordability. Adjunctive wound care, management of paradoxical reactions and rehabilitation, including physiotherapy and psychosocial support, are essential components of Buruli ulcer management. Future efforts should focus on elucidating transmission pathways to inform prevention, developing rapid diagnostics, refining and adapting drug regimens for diverse clinical presentations and patient groups, and advancing wound care. Strengthening healthcare worker training and integrating Buruli ulcer control with that of other skin diseases will enhance accessibility to early diagnosis and treatment, prevent disabilities and deformities, and reduce stigma, ultimately ensuring better quality of life for affected individuals worldwide.